Provider Demographics
NPI:1619917176
Name:SNYDER, DEBORAH LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2001 DAY DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-8173
Mailing Address - Country:US
Mailing Address - Phone:336-468-9209
Mailing Address - Fax:
Practice Address - Street 1:102 WOODLYN DR
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-6673
Practice Address - Country:US
Practice Address - Phone:336-677-1800
Practice Address - Fax:336-677-1802
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078T5OtherBCBS OF NC PROVIDER #
NC7212829Medicaid